Quetiapine for the prevention of migraine refractory to the combination of atenolol + nortriptyline + flunarizine: an open pilot study.
BACKGROUND
Migraine is a prevalent neurological disorder. Although prevention is the mainstream treatment, some patients are refractory to standard therapies.


OBJECTIVE
To evaluate the use of quetiapine (QTP) in the preventive treatment of refractory migraine, defined as previous unresponsiveness to the combination atenolol + nortriptyline + flunarizine.


METHODS
Thirty-four consecutive patients (30 women and 4 men) with migraine (ICHD-II) and headache attacks on less than 15 days per month not overusing symptomatic medications were studied. The main inclusion criterion was the lack of response (<50% reduction in attack frequency) after ten weeks to the combination of atenolol (60 mg/day) + nortriptyline (25 mg/day) + flunarizine (3 mg/day). The patients started on QTP as the sole treatment in a single daily dose of 25 mg, titrated to 75 mg. After ten weeks, headache frequency, consumption of rescue medications and adverse events were analyzed.


RESULTS
Twenty nine patients completed the study. Among completers, 22 (75.9%; 64.7% of the intention-to-treat population) presented >50% headache reduction. The mean frequency of migraine days decreased from 10.2 to 6.2 and the average consumption of rescue medications decreased from 2.3 to 1.2 days/week. Adverse events were reported by 9 (31%) patients.


CONCLUSIONS
Although limited by the open design, this study provides a pilot data to support the use of quetiapine in preventive treatment of refractory migraine.
Krymchantowski
Abouch V
AV
Headache Center of Rio, Rio de Janeiro, RJ, Brazil. abouchkrym@globo.com
Jevoux
Carla
C
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005444:Flunarizine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control*; D009661:Nortriptyline / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D000069348:Quetiapine Fumarate; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D001262:Atenolol; D009661:Nortriptyline; D005444:Flunarizine